CFB PBL 4

Question 1

LOB 1 - Revise role of kidneys in regulation of BP

Question 2

Define CKD

Answer 2

Presence of kidney damage shown by abnormal albumin excretion or decreased kidney function measured by GFR that persists for more than 3 months

Question 3

State causes of CKD

Answer 3

• Vascular (renal artery disease, hypertension leading to vascular damage)
• Immunological (IgA - nephropathy - abnormal iga 1 production which leads to polymerisation and the position in glomeruli which leads to inflammation abd danage - chronic mucosal infection and persistent IgA response
  -Metabolic (diabetes)
  -Urinary tract obstruction (tumours, kidney stones, prosthetic hypoplasia)
  -Any cause (genetic-drugs-chronic alcohol, congenital abnormalities)

Question 4

Main signs and symptoms of chronic kidney disease to include nausea, itching, peripheral oedema and weight loss

Answer 4

• Uremia: exretory problems
  -Nausea - due to uremia
  -Itching (result of urea + phosphate in skin, leads to mast cell activation, histamine release, this activates nerve endings which causes itching)
  -Weight loss (loss appetitie + vomiting due to uremia)
  -Peripheral oedema (reduced oncotic pressure due to loss of albumin in the urine - increase hydrostatic pressure due to (a) vasoconstriction leading to high BP (b) hypervolemia. Due to aldosterone and ADH

Question 5

LOB 4

Answer 5

Cardiovascular causes:

• CHD - atherosclerosis -> High BP (causes damage to endothelial cells of coronoary arteries)
  -Arterial calcifications -> calcium phosphate depostion in blood vessels
  -Valvular disease -> ventricular enlargement + ventricular hypertrophy
  -VENTRICULAR HYPERTROPHY - MOST COMMON COMPLICATION
  because of INCREASEDS EDV (because hypervolemia) -> muscle stretch -> causes hypertrophy
  also because of increased afterload because of Ang II -> vasoconstriction

-Metabolic bone disease: Has 2 causes:
1. Ostiomalasia because of Vit D deficiency, bone resorption
2. Renal ostiodystrophy because increased phosphorus binding to free Ca, activation of parathyroid gland, increased parathyroid hormone, increased Ca resorption of bone

Question 6

Treatment of CKD

Answer 6

• Control of BP (hypertension) - ACE inhibitors
  - Ang II receptor blockers
  -Control of metabolic acidosis - Bicarbonate supplements
  -Treating of hyperlipidymia -> Statins
  Dialysis -> stage 4
  -Transplantation